Friday, December 31, 2010

Resolved for 2011

A few posts a-brewing, as always, but today feels like I ought to post something either more reflective or more forward-looking. I think forward-looking wins out!

One of my 2011 resolutions is to use social media more effectively. YES REALLY. So in light of that, I finally got around to creating a Facebook fan-page-type-thing. See over yonder in the left sidebar? ---->

Not much content up there at the moment, but that'll gradually change. Along with connecting me to y'all more directly, it'll make it a little easier to segregate the things I share from my 'real-life' Facebook friends who have little to no interest in all this stuff (there are a few, strangely, I know).

So take a second to "like" me, pretty please, and I'll have a whole slew of new fun for you in the New Year. It might even involve my own boobs. (It's not what you think.) (No, not even YOU.)

Here's to onward and upward, and cheers to you all! See you on the flipside.

Tuesday, December 28, 2010

Guess what Elmo's thinking about today? Wait, wait, don't tell me . . .

I'm a big-time NPR fan. "Morning Edition" in the morning and "All Things Considered" in the afternoon, "Fresh Air" whenever I can catch it, "This American Life" on the weekend, I'll even listen to "Car Talk" and enjoy it despite not knowing a thing about cars beyond getting from point A to point B. And one of my favorites is the quirky news quiz show, "Wait, Wait, Don't Tell Me". I love it all, and have given regularly to several stations over the years. Call me a latte liberal if you will, but NPR is most definitely a staple of my life. I feel incomplete unless I've played along with puzzle master Will Shortz on Sunday's Weekend Edition.

So I was surprised and frankly pretty annoyed to hear the following subtle dig against breastfeeding on "Wait, Wait" this past weekend. The guest of the moment, via phone, was Denis Leary, and Sesame Street was the topic:

SAGAL: So we're going to ask you three questions about that landmark kid's show.

Mr. LEARY: Oh boy.

SAGAL: Taken from the new authoritative history of "Sesame Street," called "Street Gang" by Michael Davis.

Mr. LEARY: Okay.

SAGAL: All right. First question, as I'm sure you remember, or maybe you don't, "Sesame Street" was known for introducing kids to real world concepts in a gentle way.

Mr. LEARY: Uh-huh.

SAGAL: One of the notable early examples was an episode in which one of these things happened.

[Doul-la-la note: I already know what's coming.]

Was it A: Mr. Hooper's grocery store was vandalized? B: folk singer Buffy Sainte-Marie breastfed her baby right in front of Big Bird?

(Soundbite of laughter)

SAGAL: Or C: special guest star Elizabeth Taylor explained to Grover why she had had four different husbands?

(Soundbite of laughter)

Mr. LEARY: Oh man, I'm going with A.

SAGAL: You're going to go with A?

Mr. LEARY: Yeah.

SAGAL: It was Buffy Sainte-Marie.

Mr. LEARY: I can't believe it.

(Soundbite of laughter)

Mr. LEARY: Really?

SAGAL: Yeah, she really was. She was a guest on the show for the first five seasons.

Mr. LEARY: Really?

SAGAL: They went through her pregnancy and the birth of her baby, off-screen I hope. And so she breastfed him on camera and Big Bird asked about it and eventually said, "You know, that's nice" said Big Bird.

[Dou-la-la notes: more laughter and disbelief here.]

Mr. LEARY: I can't believe Buffy Sainte-Marie breastfed her...

SAGAL: It's true.

Mr. FELBER: I can't believe Big Bird was okay with it.

And cue more laughter, and then they moved on.

Now really, I don't bring this up to bitch the regulars or the hosts of "Wait Wait" out. I really do love the show, I have nothing against Denis Leary, and might even, if pressed, admit to having a bit of a geeky audio crush on Peter Sagal, rivaled only by my other radio boyfriend, Ira Glass. I wouldn't say I'm furious about it, either - irritated, yes, but it was just a passing exchange. Perhaps it's even a bit of a stretch to call it a 'dig', maybe it's nothing more than a bit of juvenile squeamishness. I'm not calling out the lactivist dogs, asking for a boycott or even a letter-writing campaign. It's not like they're working some anti-breastfeeding agenda, it was just a thoughtless moment. But thoughtless as it was, it's also a revealing moment, and really goes to show, despite some higher initiation rates, just how backasswards we've become about it all today.

Here's the shocking segment:

Despite rendering Leary, Sagal, Felber et. al. shocked at the thought that Big Bird might be "okay" with observing a mammal feeding her young as nature designed, this was actually not the only time this was included on Sesame Street. The producers and writers apparently thought it was important and relevant enough to children that they included it again, years later, when principal actor Maria had her own baby, and they delivered essentially the same scene, with a child as the inquisitive party rather than Big Bird:

Now, I don't have the media archives to determine whether or not either of these caused waves of shock or outrage or anger or disgust among the parents of decades past. I've never heard of any major letter writing movement, and if a few viewers were disgruntled, I haven't heard anything about it. (That doesn't mean it didn't happen, so if anyone out there with access to Lexis Nexis wants to do me a favor and run some searches, I'd be grateful.)

But imagine that either Buffy or Maria did such a thing on Sesame Street today. What do you think would happen? How might the public react? With the advent of the internet, would the blogs and boards light up with frenzied debate over whether such a thing were appropriate? Would massive boycotts ensue? Would lawsuits be threatened and FCC fines be levied?

I would venture a pessimistic guess that all of the above would probably take place (note the furor over Katy Perry's cleavage earlier this year), and that would be only if the Buffy/Maria segment were re-broadcast or reproduced: mother nursing baby, unapologetically but still quite discreetly. Can you imagine if it were taken a step 'further', as it was in yet another 70's children's show?

Because on Mr. Rogers, there was once an absolutely beautiful segment on all kinds of animal mommies feeding all kinds of animal babies: kittens, calves, puppies, piglets, and humans. And in that segment, we not only see a human mother nursing, with the baby's head in the appropriate place, but we see her areola.

And not only her areola, but her NIPPLE.

And not only her nipple, but her nipple DRIPPING MILK.

And this happens twice!

Unfortunately, copyright restrictions have since made the video unavailable online, though one intrepid viewer managed to catch part of it. I prefer the full video, putting the humans in context with all other animals, and with Mr. Rogers' sweet introduction and closing words. But in a pinch, we at least have the most SHOCKING images, so I can at least prove I'm not making it up. Warning: aforementioned dripping nipple included:

Sorry if I've offended your delicate/momentarily juvenile sensibilities, Misters Sagal, Felber and Leary, should you happen to chance upon this - Mr. Rogers seemed 100% fine with it, in his quintessentially gentle and loving way.

Being me, of course, I wish PBS were in a position to bring these kinds of scenes back, though I realize today's kid requires a little more razzle-dazzle; say, in the form of a certain Red Menace (as he's known in our household). So, should any contemporary Sesame Street writers stumble across this, consider it a spec script for a new segment of Elmo's World (though those of you with littles know full well that once you know the format, it pretty much writes itself).



Hi everybody! Welcome to Elmo's World! Elmo's so glad to see you. And so is Dorothy! Say hello, Dorothy!

[Close-up on Dorothy's fish bowl. Elmo giggles.]



Nursing. You know, nursing!

[Elmo opens the door to see an image of a human mother nursing her baby. Kazoo theme plays over montage of various mothers nursing their babies in various positions. Newborns, in slings, twins in the football hold, a mother pumping and then a baby being bottlefed the expressed milk, toddlers, closing with an image of a happy baby delatching with a milk-drunk grin.]


Elmo wants to know more about nursing. Let's ask Mr. Noodle! Oh Mr. Noodle!

[Window shade flies up to show Kristen Chenoweth in Noodle Family costume.]


Oh look! It's Mr. Noodle's sister, Ms. Noodle! Let's ask her. Hi Ms. Noodle!

[Ms. Noodle waves enthusiastically, cuddling a baby doll.]


Ms. Noodle, how do you nurse a baby?

[Ms. Noodle furrows her brow, then gets an idea. She pulls out a cell phone, makes a call, then goes to the door frame accept a pizza delivery. She takes out a piece and holds it to the baby's mouth as Elmo and his chorus of kids protests.]


No, no, Ms. Noodle, that's not how you nurse a baby! Babies need milk. Try it again!

[Ms. Noodle mouths the word "Milk?", then lights up again and exits. She reenters leading a cow on a rope, lays the baby doll beneath the cow, and begins to milk it, aiming the milk into the baby's face. Elmo and the peanut gallery protests again as the sound effect of a baby starting to cry begins playing.]


No, not like that either, Ms. Noodle! The baby wants milk from her mommy, not a baby cow's mommy! Keep trying!

[Ms. Noodle picks up the baby and tries to comfort her as she cries. In the process, the baby doll "roots" and eventually latches on. A look of happy understanding passes over Ms. Noodle's face as Elmo and the kids cheer their approval.]


That's it, Ms. Noodle! You did it! Yay!

[Ms. Noodle sits back in a a rocking chair, happily nursing away. The shade closes.]


That was neat. She figured it out! Now Elmo wants to ask a baby. Hi baby!

[Camera pans left to a gurgling baby held in his mother's lap.]


Baby, how do YOU nurse?

[Straight to the point, baby latches on and demonstrates. Elmo laughs.]

Thanks baby! Now Elmo wants to learn more about nursing. How can Elmo learn even more?

[Close-up on Dorothy, with a statue of a Madonna and child in her bowl.]


Oh, that's right, Dorothy! We can ask the computer!

[Computer bounces around, and then opens up an email to Elmo from a 7 year old fan, with a shot of her riding her new bike with training wheels. She tells Elmo about her baby sister who was recently born and had to use a Lact-Aid supplementer for a little while until her mama's milk came in all the way. "It was kind of like using training wheel for my bicycle!" she says. "And now my mama can nurse without the Lact-Aid, and I can ride my bicycle all by myself." Closing shot shows the young fan riding down the street.]


Wow! There's all kinds of ways to nurse a baby. Do you think we can find out even more? How?

[The television starts bouncing around.]


Oh yeah! TV! Let's see what else there is to learn about nursing!

[The usual TV cartoon segment music begins playing, with the oddly brusque, matronly woman narrating. She tours a zoo, showing all the baby animals being nursed by their mommies, and ends by singing a song about all the animals sleeping with their mommies close by.]


Aww, that was so sweet. Elmo sometimes curls up with his mommy too!

[Knock on the door]


Hey, someone came to visit Elmo! Let's see who it is!

[BABY BEAR, his little sister CURLY BEAR, and MAMA BEAR enter.]


Hi Elmo! I understand you wewe cuwious about nuwsing! I though maybe my Mama Bear could answer some of your questions!


Sure, Elmo, ask anything you like!


You nurse Curly Bear?


That's right. It's really good for both of us. [Curly begins nursing.]


Is it hard to do, making milk?


It can take some getting used to, and sometimes mommies need some help from other mommies, but once you get started and learn how, mamas' bodies just know how to do it!


And she used to nuwse me, too!


But Elmo doesn't understand. Elmo's seen Papa bear giving Curly Bear a bottle!


Well, he does, sometimes. I can't always be with Curly, so I pump some of my milk ahead of time and store it in a bottle so Papa Bear can feed her too. That way Curly always has healthy mama's milk to eat!


That's amazing! Elmo loves nursing.


Me too!


(delatching): Me three!

[Everyone laughs.]


Yay nursing! Hooray for nursing! Let's all sing The Nursing Song!

[The piano bounces out, and they all jauntily sing "Nurse nurse nurse! Nurse nurse nurse!" to the tune of "Jingle Bells".]


Time to go now! Say goodbye Dorothy!

[Close-up on Dorothy's bowl.]


Good-bye everyone! Bye!

[Closing music.]


I can dream, can't I?

* Photo of Lucy Lawless is from when she was poster woman for World Breastfeeding Week. (Can you dig the potency of Xena's breastmilk?)

Tuesday, December 21, 2010

Some (semi) good news, and some pretty danged bad news

Two items hot off the presses this week. Which should I start with? The (somewhat) good news, you say?

First, some research just emerged which relates to both birth and breastfeeding. The impact of IV fluids - mother's intrapartum fluid balance - on a newborn's weight loss had been studied, and a connection was found between mother who received more than 200 ml per hour and newborns who lost an "excessive amount of weight" (up to 10 percent is normal and to be expected) in their first days. It turns out that, as many have suspected, babies can take in some of that excess IV fluid themselves.

How does this impact breastfeeding? Neonatal weight loss that is greater than the norm frequently prompts formula supplementation, when in fact feeding issues have nothing to do with the excessive drop in weight; baby is simply shedding the extra fluid. Early formula supplementation is a major booby trap, so it's good to have a solid basis for avoiding it whenever possible.

It's also worth noting that IV fluids often have a second significant impact on the new breastfeeding relationship: mothers who have received IV fluids can also become extremely engorged, beyond the normal fullness of mature milk 'coming in', making it (a) much more difficult for baby's little mouth to latch on, and poor latching can lead to
both inefficient milk transfer and degrees of discomfort for the mom that range from irritating to excruciating; and (b) severe, if temporary, discomfort for the mother.

This is not to say that there isn't a place for IV fluids, when necessary. But though it may not be thought of as a serious intervention in the way that we think of, say, internal monitoring or episiotomies, it is still an intervention, and should be considered carefully, both pros and cons. We now have evidence of another significant con, and it should be factored into the decision-equation.

And, the bad news. Up from 2008's figures, the U.S. cesarean rate climbed once again, from 32.3% to 32.9%. Yup, that's a new all-time high, rising nonstop for 13 years running. Unnecessarean has all the news and blues about that over yonder, check it out to commiserate and lament.

Wednesday, December 1, 2010

A Paradigm Shift is Afoot: from "combination feeding" with formula to informed milk donation

There has been a rather seismic movement afoot (pun intended) in the online breastfeeding community, as it were, over the last few weeks. If you're not in the loop, the gist of the situation is that a breastfeeding advocate named Emma Kwasnica has galvanized a Facebook-centered milksharing network online: Eats on Feets. Such a thing isn't 100% new, as a site called MilkShare has been working at the same for a while now, and those in the know might be able to find donors on boards like (I've unloaded my freezer to several strangers on MDC myself). But this is taking flight like nothing has before, and I think it has everything to do with harnessing the power of Facebook and social networking in general, and how integral it has become to many of our lives.

Other bloggers have done a great job detailing the phenomenon that is Eats on Feets, such as The Motherwear Breastfeeding Blog and One of Those Women. There's much to discuss, including the (over)reaction of the Canadian government - and I won't try to reinvent the wheel here; check out their posts! But this awesome recent development ties into something I've been struggling to write about recently anyway, which is the matter of supplementation, which, in our current Western society, is set by default to formula.

Some refer to the choice to supplement (often electively, but sometimes out of necessity) as "combination feeding" or "mix feeding". It sounds innocuous enough, right? I've heard it referred to as "the best of both worlds", and despite the crystal-clear recommendation from both the AAP and the WHO to breastfeed exclusively for a minimum* of six months, the number of women who breastfeed at all are combination feeders. By a huge majority.

Initiation rates have gone up in most areas (though there's still room for improvement), and this is a positive thing. But after even a few weeks, the number of women exclusively breastfeeding drops dramatically. Check out the CDC's latest report card: By 3 months, the number of women exclusively breastfeeding is only 33%, and by 6 months . . . 13.3%. The numbers for continued non-exclusive breastfeeding are a little bit better, if only by comparison to those exclusively breastfeeding: by that same 6 month mark, 43% are breastfeeding in combination with formula.

Let's look again from the flipside: by 6 months, 86.7% of all American babies are consuming formula.

There has been a lot of great material written about why our numbers for breastfeeding are so low. Many advocates and authors of such pieces focus on the fact that real world support is still so deeply lacking. Our initiation rates are high - should be higher, again, but still, 75% is better than it used to be - and this tells us that the message that Breast is Best has definitely gotten out there. And then, when challenges arise, it is pretty much luck of the draw whether or not the support you get will be enough to allow you to continue. Were I living in a different area, and didn't have access to the excellent IBCLC that I did, I myself would not have been able to breastfeed. It's no hyperbole. I would have been another casualty of this booby-trapped system.

But as I said, wonderful articles and posts abound on this topic. I want to think more about combination feeding and why, and how, it is so acceptable, commonplace, and even encouraged - including encouragement by professionals, despite the unmistakable consensus of their own organizations on exclusive breastfeeding.

Here's my loose hypothesis: the prevalence of combination feeding is yet another result of the well-intentioned but deeply flawed "Breast is Best!" message backfiring. How so? It's tricky, but think about statements like "Every little bit counts - it's liquid gold, after all!" and "Any breast milk is better than none!" Such sentiments abound. Are they true? Well . . . yes. But I think there's a perception out there that breast milk is so powerful that even one feeding a day is enough to confer its benefits. Breastmilk, an omnipotent panacea of mythical, even supernatural proportions - surely it will cut through all the well-documented risks of commercial, artificial infant milk. Right?

IS some breast milk better than none? Well, I'd be hard-pressed to say no. Yes, it is. But saying "yes" is so far from saying that some breastfeeding is even close to the same as exclusive breastfeeding. The immunological benefits of breastmilk are some of its most powerful, the introduction of formula actually negates these very benefits. Look at this recent study from BMJ, examining the protective effect of exclusive breastfeeding on infections in infancy. It concluded that "Partial breastfeeding was not related to protective effect."

And here's another piece on a larger study released earlier this year:

"Significantly, the study showed no health benefits for infants who received formula along with breast milk, even when partial breastfeeding extended a full six months . . . . None of the antibodies found in breast milk are able to be duplicated in manufactured formula, resulting in a significant lack of protection for formula-fed babies against infectious diseases. Formula is unable to match the complexity of breast milk, the consistency of which adapts over the first few months of a baby's life, changing to fit the baby's needs as he or she grows."
Allow me to repeat that - I apologize for belaboring the point, but I want to make sure it's not missed: "The study showed no health benefits for infants who received formula along with breast milk, even when partial breastfeeding extended a full six months."

Pretty far from "Every little bit of liquid gold counts!", isn't it? Why is this? If breast milk is so powerful - and it IS; believe me, I'm not saying it isn't the very definition of a vital substance - then how can the introduction of a little formula negate it? Much of this has to do with the effect it has on our intestinal, or 'gut' bacteria. This IS where our immune system is centered, and what takes place when foreign proteins are introduced is significant. If you have never read The Case for the Virgin Gut, I implore you to do so**. From the piece:
"When babies are born, they have sterile gastrointestinal tracts. If babies are exclusively breastfed, they develop a natural healthy gut flora. (When I speak of the gut, I mean Baby's insides where the food goes until it hits the diaper.) This means that the major flora in breastfed babies has reduced numbers of bad types of bacteria and increased numbers of good bacteria. Formula-fed babies have increased numbers of bad bacteria, leaving them at more risk for illness.

Having knowledge of the importance of what is normal for newborns inside may help some mothers in making a decision about whether or not to supplement their babies for convenience in the early weeks. Very few mothers know how totally different babies are on the inside when artificial food is added to their diets. Some mothers add the formula in the hopes that their babies will sleep longer at night. Knowing that only one bottle a day can totally change the protective environment of their baby's gastrointestinal tract may give them pause to reconsider before instituting this practice.

The case for the virgin gut is a valid one. There is much research to support avoiding supplementation if at all possible. A huge increase in diarrheal diseases occurs in babies who do not have optimal "intestinal fortitude," which is only possible with guts that have never been exposed to infant formula."
Yet again, something touted as the best of both worlds is revealed to not be the best of either, something I've blogged on before - it's practically a series.

Where does this leave us? Despite the overbearing harpy cliche, I'm coming to feel that breastfeeding advocates, including lactivists and educators as well as some medical professionals, ARE extremely sensitive about pressuring new moms, and want so badly to be reassuring and accepting and above all, non-judgmental . . . so much so that they/we end up understating the risks of formula feeding. Do what you can. Of course some breast milk is better than none. It's okay. You do what you can.

It's a conundrum. We DO need to be supportive. We DO need to be inclusive. We DO need to be non-judgmental. But we also need to make sure that mothers have all the relevant information, all the facts, in order to make empowered choices. Choice, yes, but informed choice. We need to not undermine parents right out of the gate by telling them that (as I witnessed from a professional firsthand) The breastfeeding bag they give you at the hospital has a bottle of formula in it, and that's there to tell you that hey! it's okay to do both! You don't have to choose!

As anyone reading this blog is likely aware, in addition to the risks for the infant, supplementation not done carefully leads to diminishing supply, and if the mother is not aware of how this works, mom's assumption is that something is wrong with her, that she "just couldn't make enough milk", and the slippery slope to total cessation of nursing has already begun. There has to be a way of being compassionate and inclusive without saying things like, as I have also heard with my very own ears from a pro, "If you want to nurse for 6 weeks and then start using formula, that's okay! Whatever works for you! If you want your husband to give a bottle of formula overnight so you can sleep, that's okay! Whatever works for you!"

But there ARE cases, as we know, where supplementation IS necessary. There is no denying that. We want to reduce these cases, but there absolutely are times when it is needed, such as moms with hypoplasia/IGT, or with some BFAR moms, for instance. And here's where the paradigm shift comes in.

It's time that donor milk becomes a real possibility for mothers.

Despite formula companies spending millions to convince you that their product is the "next best thing" to human milk, the WHO designates formula as fourth best - dead last, in other words. The first choice is simply mother breastfeeding her own child, and then pumped milk from the same mother to her own child. Then, third best, is donor milk from another mother, not formula. Yet when supplementation proves to be necessary (either temporarily or long-term), the default in our society is to go directly to formula. Then begins a cycle of figuring out which formula is less difficult for the baby's system. Do we try the "gentle" variety? What if milk is the problem - do we do soy? If that's not working, on to the hydrolyzed and painfully expensive kinds. What if donor milk was a viable option? What if it wasn't just a vague possibility - difficult to pull off in the short term and even harder to do over any substantial length of time - what if donor milk was, instead, the default?

Now, milk banking has been around for a while, and while I think it's basically a good thing (as in HMBANA), to say that it's prohibitively expensive for most families is an understatement, and can be difficult to impossible to get unless your child is ill. Doctors can prescribe it and SOME insurance companies are starting to cover it - but we're a long ways from this being the standard. There's always talk of making banked milk more plentiful and accessible (as the Canadian government stated in response to the growth of Eats on Feets), but that time has definitely not yet arrived.

Doesn't milk sharing and direct donor milk (as opposed to the pasteurized kind one can gets from banks) carry some risk, though? Yes it does. There are diseases that are communicable via breastmilk, and it's absolutely wise to vet the donor in whatever way both parties feel comfortable, wether there's a formal or an informal process in place. I've given milk directly to moms who knew me and trusted me, and have done a little bit of wet nursing, but to one mother who found me via MDC, I submitted a medical record of my most recent blood workup, which I thought was totally fair and the other mom seemed satisfied by this. It still involves some trust, but the risks taken in accepting donor milk must be weight against the risks of infant formula. PhD in Parenting has already done a bang-up job of doing just that (though of course every parent has to make this comparison on their own, as she illustrates).

As someone who participated in a nursing support group where milksharing was common, and donated literally gallons of my own milk to several babies, I am so pleased that since mothers are frustrated with the admirable but glacial progress of milk bank accessibility, they are making their own informed choices, taking this into their own hands - and feets.

*This is something that gets lost in translation, telephone game style. I have heard and read more than one mother claiming that the recommendation is to breastfeed for six months, period. They literally interpret the recommendation -whether second or third or fourthhand through peers, or not explained well enough by professionals, or misread in a book - as endorsing breast feeding for six months
and no longer.

** Another helpful link on the subject: Just One Bottle Won't Hurt - Or Will It?